Acute urinary retention as the initial manifestation of Guillain-Barre syndrome

Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
The American journal of emergency medicine (Impact Factor: 1.27). 07/2011; 29(6):696.e3-4. DOI: 10.1016/j.ajem.2010.06.013
Source: PubMed


Guillain-Barre syndrome is a leading cause of acute weakness in young and middle-aged people [1,2], but it can affect patients of all ages. The main features of Guillain-Barre syndrome are ascending limb weakness which is relatively symmetric and progresses rapidly, with or without involvement of respiratory or cranial nerve-innervated muscles. In typical cases, possible initial symptoms include pain, numbness, paraesthesia, or weakness of the limbs [3,4]. Guillain-Barre syndrome also has a significant mortality in the first month [5,6]; however, this condition is often initially misdiagnosed [7], because the initial symptoms are often nonspecific, and many clinical variants may present [8]. Therefore, it is mandatory to maintain a high index of suspicion for this disease so as to prompt early diagnosis and treatment. Herein, we reported a case of Guillain-Barre syndrome who rapidly progressed to respiratory failure with an initial presentation of only acute urinary retention.

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    • "Various studies suggest longer-term supportive care for pwGBS in the community.2,11,16 The existing studies12,13,17-21 however, report urinary dysfunction in acute phase of GBS only, while those in the chronic phase in the community have not been studied. The primary aim of this study is to describe the prevalence, disease characteristics and factors impacting bladder dysfunction and impact on QoL in pwGBS in the post-acute phase in the community. "
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    ABSTRACT: Urinary dysfunction is associated with significant morbidity in persons with Guillain-Barré Syndrome (GBS). The aim of this study was to describe prevalence and long-term impact of bladder dysfunction on daily activities and quality of life (QoL) in persons in chronic phase of GBS and to examine the relationships between commonly used continence measures in this cohort. Prospective cohort (n=66) following GBS treatment (1996-2009) was recruited from a tertiary hospital and assessed using standardised measures for bladder dysfunction: American Urological Association (AUA) Symptom Index, Incontinence Impact Questionnaire, Urogenital Distress Inventory. Sixty-six participants (64% male, mean age 56 years, median disease duration of 6.1 years) completed the study. Of these more than half reported nocturia and one-third reported urinary urgency and frequency. Urinary problems impacted on participants' daily activities: physical recreation (21%), emotional health and mood (17%), entertainment (14%), participation and mobility (>30 min) (12%), and performance of household chores (8%). Since GBS, 49% reported interference of urinary symptoms with daily life to some extent; and adverse impact on QoL (10.6%). Significant relationship between bladder symptoms; and the level of urogenital distress (p<0.001) and the impact of urinary problems (p<0.001), was noted. Higher scores on the bladder scales showed significant correlations with psychological, functional and participation scales. The single QoL item (AUA scale) correlated significantly with all other bladder scales (rho=0.63-0.86). This can be a potential 'screening tool' to identify patients for further assessment. Bladder dysfunction in chronic phase of GBS is not well studied. More research in longer-term screening and outcomes for bladder intervention are needed for integrated care and to guide treating clinicians.
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